A mobile based user centred integrated remote patient monitoring framework for low resource settings

There is a gap in healthcare service delivery within low resource settings of South Africa. These areas are under-serviced because of poor health infrastructure and few available medical experts. This contributes immensely to poor health care delivery especially to chronically ill diabetic patients and increases mortality rates. However, innovative remote patient monitoring (RPM) systems have been developed to curb the above challenge in recent years. Unfortunately, most of these systems are standalone and are incompatible with one another. Most of them relay on Internet for connectivity which is imminent in low resource settings. This makes continuity of care of chronic ill patients a great challenge. Additional, the efficacy and feasibility of RPM using mobile phones in low resource settings of South Africa are still unknown. It was also noted that none of these systems have been developed for a clinical trial. The goal of this study was to provide a standard framework that allows optimal design of mobile RPM systems which are interoperable. The objectives were to investigate the RPM system efficacy and reliability in low resource settings and determine its effects on clinical management, self-care and health outcomes. The framework was validated with a clinical trial to remotely monitor diabetic adults in Limpopo province of South Africa. A prototype system was developed based on sound user centric design process and enterprise architectural principles to remotely monitor diabetic elderly patients using cellular technologies and existing hospital infrastructure. It was evaluated using a controlled, randomized clinical trial for 6 months. There were 120 patients who took part in the study and were categorized into two groups, the intervention Group X and the control Group Y. Each group comprised of 60 participants. Evidence from this study justified the feasibility and possibility of long term implementation of RPM system to cater for chronic ill patients in low resource settings worldwide. Results showed that the self-care and normal blood glucose levels improved for both groups whereas quality of life improved only for Group X. It was shown that extensive self-care knowledge with the help of RPM system improved self-care and helped normalize their glucose levels. The hospital admissions and mortality between the two groups did not differ much. However, the intervention group had more hospital visits than the control group because the participants were requested to visit the hospitals in case of emergency. The users perceived the RPM system as feasible and effective way of clinical management and self-care. Due to wide acceptance, some patients were even willing to continue using the system after the trial. Home measurements proved to be reliable and helped improve self-care. In future, a standardized and unified framework based on rule set would provide comprehensive remote healthcare allowing continuous patient monitoring at a reduced overall cost thereby decreasing mortality rates

Investigating wireless network deployment configurations for marginalized areas

In recent years, immense effort has been channelled towards the Information and Technological development of rural areas. To support this development, telecommunication networks have been deployed. The availability of these telecommunication networks is expected to improve the way people share ideas and communicate locally and globally, reducing limiting factors like distance through the use of the Internet. The major problem for these networks is that very few of them have managed to stay in operation over long periods of time. One of the major causes of this failure is the lack of proper monitoring and management as, in some cases, administrators are located far away from the network site. Other factors that contribute to the frequent failure of these networks are lack of proper infrastructure, lack of a constant power supply and other environmental issues. A telecommunication network was deployed for the people of Dwesa by the Siyakhula Living Lab project. During this research project, frequent visits were made to the site and network users were informally interviewed in order to gain insight into the network challenges. Based on the challenges, different network monitoring systems and other solutions were deployed on the network. This thesis analyses the problems encountered and presents possible and affordable solutions that were implemented on the network. This was done to improve the network‟s reliability, availability and manageability whilst exploring possible and practical ways in which the connectivity of the deployed telecommunication network can be maintained. As part of these solutions, a GPRS redundant link, Nagios and Cacti monitoring systems as well as Simple backup systems were deployed. v Acronyms AC Access Concentrators AMANDA Automatic Marylyn Network Disk Archiver CDMA Code Divison Multiple Access CGI Common Gateway Interface